Provider Demographics
NPI:1831205293
Name:POTOMIC MEDICAL SUPPLIES, INC
Entity type:Organization
Organization Name:POTOMIC MEDICAL SUPPLIES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DOMINIC
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDUFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-270-0612
Mailing Address - Street 1:8957 EDMONSTON RD
Mailing Address - Street 2:SUITE Q
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-1005
Mailing Address - Country:US
Mailing Address - Phone:301-270-0612
Mailing Address - Fax:301-270-1487
Practice Address - Street 1:8957 EDMONSTON ROAD
Practice Address - Street 2:SUITE Q
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770
Practice Address - Country:US
Practice Address - Phone:301-270-0612
Practice Address - Fax:301-270-1487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD406117900Medicaid
5354780001Medicare ID - Type Unspecified